Scleral Lenses for Severe Dry Eyes
What Are Scleral Lenses?
Scleral lenses are large-diameter rigid lenses that vault over the cornea and rest on the white part of the eye, known as the sclera. They create a fluid-filled reservoir that protects and hydrates the ocular surface throughout the day.
Scleral lenses have a unique, bowl-like shape that vaults over the cornea and lands gently on the sclera. This design creates a space that is filled with sterile saline solution to keep the eye surface hydrated and shielded from external irritants all day long.
Unlike soft lenses, which conform to the corneal shape and can worsen dryness, scleral lenses do not touch the cornea, reducing irritation. Compared to smaller rigid gas permeable lenses, scleral lenses are larger, which enhances comfort and stability, making them ideal for irregular corneas and severe dry eye patients.
Scleral lenses are made from highly oxygen-permeable materials that allow adequate oxygen to flow to the cornea despite their size. This is critical for maintaining long-term corneal health and preventing complications during extended wear.
How Scleral Lenses Help Severe Dry Eyes
By creating a fluid reservoir and shielding the ocular surface, scleral lenses address both the symptoms and underlying surface damage associated with severe dry eye conditions.
The lens is filled with a sterile saline solution before insertion, creating a continuous reservoir of moisture that bathes the cornea. This tear reservoir keeps the eye surface hydrated, smooths the ocular surface for clearer vision, and reduces dryness symptoms for extended periods.
The fluid layer acts as a cushioning barrier that prevents direct contact between the lens and the sensitive corneal surface, minimizing friction. It also protects against environmental factors such as wind, dust, and allergens, which allows damaged or compromised corneas to heal.
The scleral lens rests on the less sensitive sclera, avoiding contact with corneal nerves that often cause discomfort with other lens types. This stable fit, combined with the fluid cushion, helps reduce the burning, scratching, and foreign body sensation common in severe dry eye patients.
By creating a smooth optical surface over an irregular or damaged cornea, scleral lenses correct astigmatism and other distortions. This results in clearer, more stable, and more reliable vision throughout the day.
Since the lenses provide continuous moisture and protection, many patients experience a reduced reliance on frequent artificial tear use. This simplifies daily dry eye management and improves overall convenience.
Who Can Benefit from Scleral Lenses?
Scleral lenses are suitable for patients with significant tear film deficiencies or advanced corneal surface disorders that make wearing conventional lenses difficult or impossible.
Patients with conditions like Sjögren’s syndrome or graft-versus-host disease, or those with inadequate tear production, benefit from the constant hydration scleral lenses provide. This can relieve pain and redness, helping prevent long-term corneal damage.
In diseases like keratoconus where the cornea loses its normal shape, scleral lenses vault over the irregular surface. The fluid reservoir creates a smooth new refractive surface, offering clearer and more stable vision than glasses or other contacts.
Following procedures such as corneal transplants, cross-linking, or refractive surgery, scleral lenses protect the sensitive healing tissue. They maintain moisture, reduce discomfort, and shield the eye during the recovery phase.
Conditions like Stevens-Johnson syndrome, neurotrophic keratopathy, and chemical burns severely damage the ocular surface. Scleral lenses manage these conditions effectively by shielding and hydrating compromised tissue, reducing pain and promoting healing.
Patients who cannot tolerate soft or smaller rigid lenses due to persistent dryness, discomfort, or an irregular corneal shape often find scleral lenses to be a comfortable alternative that allows for longer wear time and better symptom control.
Getting Fitted for Scleral Lenses
A comprehensive and precise fitting process ensures that your scleral lenses provide maximum benefit, comfort, and safety.
An in-depth assessment evaluates the severity and type of dry eye, ocular surface health, and any potential contraindications to lens wear. This ensures that scleral lenses are a safe and suitable option for your specific needs.
Advanced diagnostic tools such as corneal topography and scleral mapping are used to capture the exact dimensions of your cornea and sclera. These precise measurements are essential for designing a lens that is customized to your unique eye shape.
Your initial fitting will involve testing multiple trial lenses to refine vault height, edge alignment, and fluid reservoir depth. Follow-up visits allow our team to make fine-tuning adjustments to optimize fit, comfort, and vision.
After your lenses are finalized, you will receive thorough, hands-on training on how to properly insert, remove, clean, and handle them. This education is key to ensuring safe, effective use and long-term success with your scleral lenses.
Caring for Your Scleral Lenses
Maintaining a strict hygiene routine and proper lens care are essential for preventing infections, ensuring comfort, and prolonging the life of your lenses.
After removal, rub your lenses gently with a recommended rigid lens cleaner and rinse thoroughly with a sterile solution. This removes debris, protein deposits, and bacteria that can irritate the eye or reduce lens clarity.
Always wash your hands thoroughly with soap and water before handling your lenses. Fill the lens bowl completely with preservative-free sterile saline before insertion. Use a small plunger or the proper pinch method for removal to protect the lens integrity.
Lenses must be stored overnight in a fresh, approved disinfecting solution designed for gas permeable lenses. Avoid using tap water or multipurpose solutions intended for soft lenses, as this increases the risk of serious eye infections.
Periodic eye exams allow your provider to monitor the lens fit, your ocular health, and the condition of the lenses themselves. These check-ups are important for making timely adjustments and avoiding complications.
Benefits and Risks
Understanding both the advantages and potential drawbacks of scleral lenses helps patients make informed decisions about their eye care options.
Scleral lenses provide multiple significant benefits for patients with challenging eye conditions.
- Consistent ocular surface hydration for long-lasting relief from dryness
- Enhanced visual acuity and stability for irregular corneas
- Protection from environmental irritants such as wind, dust, and allergens
- Reduced dependence on frequent use of artificial tears and medications
- Improved quality of life and ability to perform daily activities
Though generally safe, some potential risks and side effects should be considered.
- Initial adaptation discomfort, redness, or foreign body sensation
- Lens fogging or trapped bubbles that can temporarily impair vision
- Risk of eye infections if hygiene and cleaning instructions are not followed
- Potential for conjunctival or scleral pressure spots that require lens modification
- Difficulty with lens handling, which typically improves with practice and training
The cost of scleral lenses includes the custom lens fabrication, the fitting process, and follow-up care visits. Many insurance plans offer partial or full coverage for medically necessary scleral lenses. We recommend discussing financial details with your provider to understand your expected expenses.
Frequently Asked Questions
Here are answers to some of the most common questions patients have about scleral lenses.
Most patients adapt quickly, typically within a few days to a week. Proper fitting and patient education help ease the initial adjustment to the larger lens size and handling techniques.
Patients generally wear scleral lenses for 10 to 12 hours daily, but the comfortable wear time can vary based on your individual eye health and your doctor’s guidance.
Only preservative-free sterile saline should be used to fill the lens bowl before insertion. Medicated or lubricating eye drops should only be applied after you remove the lenses, unless your eye care provider advises otherwise.
Costs depend on the complexity of the lens design, fitting process, and materials. Insurance coverage varies, so it is important to discuss the financial details with your provider to understand your expected expenses.
Yes, these lenses are very effective at correcting astigmatism, especially irregular astigmatism caused by conditions like keratoconus. They create a perfectly smooth refractive surface over the cornea, leading to improved vision clarity.
Other treatments include moisture chamber goggles, punctal plugs, prescription medications, and advanced in-office therapies. Scleral lenses are often used when these other options do not provide sufficient relief.
Yes. The protective fluid layer and the barrier created by the lens can alleviate the glare and photophobia that are often experienced in severe dry eye conditions.
If you experience any persistent pain, redness, or a sudden change in vision, you should remove the lenses immediately. Contact your eye care provider promptly to have the fit evaluated and to prevent any serious complications.
No, scleral lenses are not approved for overnight wear. Sleeping in them significantly increases the risk of eye infections and reduces the oxygen supply to your cornea. Always follow your provider’s recommended wearing schedule.
With proper care, scleral lenses typically last for one to two years. Your eye doctor will assess their condition at your regular follow-up visits and let you know when they need to be replaced.
They can be very helpful during allergy season, as they shield the eye from airborne allergens like pollen. However, thorough daily cleaning is essential to ensure allergens are not trapped under the lens.
Yes, scleral lenses can be an excellent option for children with severe dry eye or corneal irregularities. This requires a careful fitting by an experienced specialist and dedicated support from parents for handling and care.
Next Steps
If severe dry eyes are impacting your quality of life, schedule a comprehensive evaluation with our eye care team to determine if scleral lenses are the right solution for you.